Human life is awash in physical and psychological pain, but many contemporary medical approaches to pain, by focusing on technological interventions within a biomedical imaginary, neglect pain’s existential, spiritual, and psychological dimensions, and neglect important pathways to healing. In this panel we will explore three different dimensions of religious resources for engaging and tending to people who are in pain.

Should Psychiatrists Promote Transcendent Virtues?

The language of virtues and character strengths runs deeply within psychological research on human flourishing. It is increasingly evident, for example, that gratitude and forgiveness contribute to mental health outcomes. Authors such as Duff Waring have argued that the promotion of self-regarding virtues has a place in psychotherapy. And virtuous qualities are increasingly recognized as important to professionalism and resilience.

Virtues often have a transcendent dimension. For example, gratitude can imply a giver, forgiveness being forgiven by someone, and accountability being accountable to an ultimate authority. “Theological” virtues such as faith, hope and love even more often refer to transcendent realities – the world containing a basis for faith, life containing hope, love being possible and important.

Western psychiatrists often feel that their scientific orientation precludes engagement with transcendent realities, and clinicians may wonder what stance to take towards them in their work. The clinician’s role in three common clinical situations - depression, moral injury and paranoia – is instructive in this regard.Seriously depressed individuals who struggle with whether their lives have value may not be satisfied with the invitation of a therapist to explore how and why their perceptions of reality are distorted. They may also need to see and even hear that the therapist believes their life is worth living.

Individuals struggling in therapy with realistic guilt over harmful actions may wonder if they can find forgiveness. In addition to exploring the reasons why they may feel undeserving of forgiveness available for example through their faith tradition, they often need to feel that their therapist believes they can be forgiven.

Patients crippled by mistrust, whether from a traumatic past or a paranoid disorder, struggle with whether to risk making themselves vulnerable to others. They need to see that their therapists believe that meaningful relationships are possible, and worthwhile.

Drawing on clinical cases, the first presenter will argue that while it is important and can be challenging to distinguish one’s personal from therapeutic values, patients need to feel that their therapist is taking a value based stand on their behalf (“You are worth our effort”, “there is hope”). Therapeutic values need to be personally held and grounded in the therapist’s view of the world. Recognizing this has several potential implications: First, rather than a boundary crossing to be avoided, engaging the patient’s existential and moral context is integral to caring for them as a whole person. Second, to promote flourishing as well as recovery clinicians may need to recruit resources for supporting virtue, such as spiritual practices and Twelve Step or faith communities. Third, examination of one’s own world view and countertransference toward the patient’s is clinically important. Fourth, clinicians need to learn ways of helping patients relate their emotional and transcendent concerns, for example through spiritually sensitive or integrated psychotherapy.

Courageous Surviving: St. Thomas Aquinas, Courage, and Trauma

Trauma, with its capacity to “overwhelm the ordinary systems of care that give people a sense of control, connection, and meaning” (Judith Herman), may seem to be a poor fit with the orderly world of virtue theory; insofar as virtues exist under the conditions of trauma, they would seem to be “burdened virtues” (Lisa Tessman). The second presenter, however, will argue that St. Thomas Aquinas’ account of the moral virtue of courage in the Summa theologiae offers a helpful framework for trauma survivors, both naming trauma’s existential reality and suggesting practices helpful for recovery. For Aquinas, courage (fortitude) is the disposition to stand squarely in the face of life-threatening danger, to feel appropriate fear, and nonetheless to stand firm and to move forward in the pursuit of justice (STh IIaIIae q. 123). Because courage requires healthy fear, it also requires love and respect for one’s body and one’s life, and a clear reckoning of danger: courageous surviving, for Aquinas, is distinct from reckless or indifferent surviving. Courage requires confidence (fiducia), the capacity to move boldly toward justice, and especially endurance, which Aquinas links to the virtues of patience and perseverance. Far from being naïve, then, Aquinas’ Christian virtue theory avoids the narrow focus on symptoms that characterizes some medical approaches to trauma, and provides practical, realistic, and helpful conceptual resources for those who seek to live courageously in the aftermath of trauma. Specifically, Aquinas’ account of courage accounts for (a) the stakes of trauma, (b) the role of self-love in surviving trauma, (c) the deep importance of divine assistance and the assistance of others in surviving trauma, (d) the close association of trauma with depression, and (e) the integral link between courage and the pursuit of justice.

Orthodox Christian Sacraments as a Resource in Healing and Dealing with Pain

Pain is often a reminder of the frailty of the human condition. Irrespective of the cause, there often comes a lonely isolation that threatens to overtake the soul. Ancient traditions of faith have approached this in a variety of ways over the centuries. In the Orthodox Christian tradition, God encounters the sick through the sacrament of the unction. In this sacred practice, as with psychiatry, there is an emphasis on the healing presence that unites the person struggling with a source of healing. In the ancient Christian understanding, the sacrament allows for union or communion with the very person of Christ much like the sacrament of the Eucharist. Pain becomes a portal by which the individual can unite with the incarnate God who took on human pain and sanctified it in Himself. In the process, , the aim becomes not only physical healing but also sanctification. The unction also ties the patient to the community and breaks the lonely isolation of illness. The body of Christ, or the Church, is commanded to be present with the patient and embrace him, irrespective of the source of illness. "Is anyone among you sick? Let them call the elders of the church to pray over them and anoint them with oil in the name of the Lord." (James 5:14) Thus the practice attempts to restore health to all dimensions of personhood. This is achieved through prayer for physical healing, forgiveness of sin for the restoration of the soul to right union with its creator, and the presence of the community of the body of Christ. The soul, body and mind are attended to.Psychiatry, likewise, attempts to bring healing and restoration in the fragmentation of illness and can benefit from the perspective of this ancient practice. First, by recognizing the hidden “Sacramental” element of psychiatric treatment which cannot always be quantified but lifts the focus from reduction of symptoms to healing of a person. Secondly, by seeing the value and power of presence in the face of pain, which precedes other therapeutic interventions Lastly, by connecting the patient to the divine through a shared experience of a Being who also truly suffered and has given meaning to this suffering.